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UM Nurse Consultant
Aetna - 2,080 reviews - Woodland Hills, CA 91367
Utilization Management experience required. Requires an RN with unrestricted active license. Click here to review the benefits associated with this position....
Case Management and Utilization Review Nurse Manager
Clinical Management Consultants - Carmel-by-the-Sea, CA
$97,389 - $149,762 a year
The Utilization Review RN Manager will ensure concurrent review staff are educated in business service lines and maintain current knowledge of the MCG criteria....
Utilization Review Nurse Director
Clinical Management Consultants - San Bernardino, CA
$120,000 - $135,000 a year
Utilization Review Nurse Director Job in San Bernardino CA. The Utilization Review Nurse Director should enjoy living and working in an area with a strong...

Utilization Management RN

UnitedHealth Group - 5,046 reviews - Cypress, CA 90630
Perform utilization and concurrent review of inpatient cases using Milliman criteria. Experience with utilization review for an insurance company or in a...

Manager, Healthcare Services (Remote)

Molina Healthcare - 376 reviews - Long Beach, CA
Ensures completion of staff quality audit reviews. Collates and reports on Care Access and Monitoring statistics including plan utilization, staff productivity,...

Quality Review Nurse (RN)

San Francisco Health Plan - 11 reviews - San Francisco, CA 94103 (South Of Market area)
Reviews clinical quality processes and identifies workflow enhancements. A current CA RN license to practice without restriction....

Clinical Documentation Specialist

UCLA Health - 41 reviews - Los Angeles, CA
RN, Coding Specialist, preferred Degree:. Provides required/requested information, inappropriate resource utilization, statistical data or reports for Hospital...

Utilization Review

Hansei Solutions - Los Angeles, CA 90034
The Utilization Review Coordinator conducts initial and concurrent reviews with respective payers. Participates in the education of other departments regarding...
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RN Home Care Coordinator - Purchased Home Care

Veterans Affairs, Veterans Health Administration - 2,603 reviews - Los Angeles, CA
$83,584 - $124,325 a year
Functions as an RN coordinating referrals to non-VA home care agencies. At least 1-3 years of successful RN experience in an acute care setting preferred....

RN-Utilization Mgmt/Intake Nurse-Resnick

UCLA Health - 41 reviews - Los Angeles, CA
The UM/Intake nurse assists with patient access to the hospital, conducts telephone assessments regarding hospital admissions, communicates information...

Outside Care Clinic Reviewer RN

Kaiser Permanente - 4,388 reviews - Pasadena, CA
Profiling of non-plan providers, utilization patterns, direct interaction with providers to discuss, review and query services provided, charges and/or expenses...


Doctors Medical Center of Modesto - 5 reviews - Modesto, CA
The Utilization Review Nurse ensures quality, cost-effective patient care through planning; Reporting to the Manager of Case Management, the Utilization Review...

Clinical Nurse Auditor - LVN / RN

SynerMed - Innovating Healthcare - Monterey Park, CA 91754
RN. Retrospective Case Review:. The Clinical Nurse Auditor (LVN/RN) performs medical case audit review to assist our claims department with retrospective...
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MDS Coordinator - RN/LVN
Brookdale - 1,279 reviews - Bakersfield, CA
Participates in the management of the current Resource Utilization Group (RUG) governed by the organizational systematic approach....
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Utilization Review Intake Coordinator
Arissa Cost Strategies - Irvine, CA 92614
Experience with Utilization Review software programs. A Workers’ Compensation Managed Care Company in Southern California is seeking a full time data entry...
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